International Journal of Hematology and Oncology
2023, Vol 33, Num 4 Page(s): 098-106
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Long-Term Side Effects of Hematopoietic Stem Cell Transplantation in Children: A Single Center Experience
Oguzhan BABACAN1, Orhan GURSEL1, Mehmet SALDIR2, Ibrahim EKER1, Erman ATAS3, Erkan SARI4, Muzaffer Kursat FIDANCI5, Sebahattin VURUCU6, Turker TURKER7, Salih ALTUN8, Vural KESIK3, Avni ATAY1, Ahmet Emin KUREKCI1
1Gulhane Military Medical Academy, Department of Pediatric Hematology, Ankara, TURKEY
2Gulhane Military Medical Academy, Department of Pediatrics, Ankara, TURKEY
3Gulhane Military Medical Academy, Department of Pediatric Oncology, Ankara, TURKEY
4Gulhane Military Medical Academy, Department of Pediatric Endocrinology, Ankara, TURKEY
5Gulhane Military Medical Academy, Department of Pediatric Cardiology, Ankara, TURKEY
6Gulhane Military Medical Academy, Department of Pediatric Neurology, Ankara, TURKEY
7Gulhane Military Medical Academy, Department of Public Health, Ankara, TURKEY
8Gulhane Military Medical Academy, Department of Ophthalmology, Ankara, TURKEY
Keywords: Hematopoietic Stem Cell Transplantation, Long-Term Side Effects, Child
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has the potention to provide curative therapy for selected benign and malignant disorders. In patients undergoing allo-HSCT in childhood, long term side effects are increased as with the prolonged survival time. Fifty-one patients underwent allo-HSCT between 2001-2014 and survived for at least two years were enrolled in this study. Clinical evaluation with detailed physical examination and required laboratory tests were done routinely to determine long term side effects. Mean follow-up period after allo-HSCT was 68.3±31.4 months (range: 24-141 months), patients’ age average was 9.3 ± 4.9 years (range: 6 moths-17 years), 56.9% of them were male, and 92.2 % (n= 47) of donors were match family donors. We determined long term side effects in 56.8% of patients. Most of the long term side effects were endocrine complications with 17.6%. Oculary long term side effects were found in 15.7% and associated with haploidentical and match unrelated donor (MUD) transplantations (p= 0.002). We found that chronic graft versus host disease (GVHD) rate was increased with MUD transplantation (p=0.003) and acute liver GVHD (p= 0.002). Osteoporosis frequency was positively correlated with follow-up time (p= 0.002) and found much more in malign disorders than benign ones (p=0.002). Osteoporosis was rarely found in conditioning regimens included cyclophosphamide (p= 0.004). Long-term side effect risk was higher in patients underwent allo-HSCT in older age (p= 0.003). Patients need to be monitored routinely for a long time after allo-HSCT. Haploidentical and MUD transplantation increase long term side effects. Future wide-spread studies are necessary to determine long term side effects of allo-HSCT-received children.
Oguzhan BABACAN1, Orhan GURSEL1, Mehmet SALDIR2, Ibrahim EKER1, Erman ATAS3, Erkan SARI4, Muzaffer Kursat FIDANCI5, Sebahattin VURUCU6, Turker TURKER7, Salih ALTUN8, Vural KESIK3, Avni ATAY1, Ahmet Emin KUREKCI1
1Gulhane Military Medical Academy, Department of Pediatric Hematology, Ankara, TURKEY
2Gulhane Military Medical Academy, Department of Pediatrics, Ankara, TURKEY
3Gulhane Military Medical Academy, Department of Pediatric Oncology, Ankara, TURKEY
4Gulhane Military Medical Academy, Department of Pediatric Endocrinology, Ankara, TURKEY
5Gulhane Military Medical Academy, Department of Pediatric Cardiology, Ankara, TURKEY
6Gulhane Military Medical Academy, Department of Pediatric Neurology, Ankara, TURKEY
7Gulhane Military Medical Academy, Department of Public Health, Ankara, TURKEY
8Gulhane Military Medical Academy, Department of Ophthalmology, Ankara, TURKEY
Keywords: Hematopoietic Stem Cell Transplantation, Long-Term Side Effects, Child
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has the potention to provide curative therapy for selected benign and malignant disorders. In patients undergoing allo-HSCT in childhood, long term side effects are increased as with the prolonged survival time. Fifty-one patients underwent allo-HSCT between 2001-2014 and survived for at least two years were enrolled in this study. Clinical evaluation with detailed physical examination and required laboratory tests were done routinely to determine long term side effects. Mean follow-up period after allo-HSCT was 68.3±31.4 months (range: 24-141 months), patients’ age average was 9.3 ± 4.9 years (range: 6 moths-17 years), 56.9% of them were male, and 92.2 % (n= 47) of donors were match family donors. We determined long term side effects in 56.8% of patients. Most of the long term side effects were endocrine complications with 17.6%. Oculary long term side effects were found in 15.7% and associated with haploidentical and match unrelated donor (MUD) transplantations (p= 0.002). We found that chronic graft versus host disease (GVHD) rate was increased with MUD transplantation (p=0.003) and acute liver GVHD (p= 0.002). Osteoporosis frequency was positively correlated with follow-up time (p= 0.002) and found much more in malign disorders than benign ones (p=0.002). Osteoporosis was rarely found in conditioning regimens included cyclophosphamide (p= 0.004). Long-term side effect risk was higher in patients underwent allo-HSCT in older age (p= 0.003). Patients need to be monitored routinely for a long time after allo-HSCT. Haploidentical and MUD transplantation increase long term side effects. Future wide-spread studies are necessary to determine long term side effects of allo-HSCT-received children.
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